Abstract
Background
Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus (HPV) infections among women and girls may be symptomatic or asymptomatic.
Objectives
To survey and identify C. trachomatis, N. gonorrhoeae, and HPV infections in symptomatic and asymptomatic women and girls in Bangkok and surrounding neighborhoods using molecular techniques, evaluate the use of doxycycline treatment for clinically symptomatic patients infected with C. trachomatis, and identify possible genetic mutations associated with persistence and/or drug resistance.
Method
We enrolled 150 women and girls with inflamed urogenital tracts and 134 asymptomatic controls, both without a history of HIV infection or cervical cancer in this prospective study. Genomic DNAs were extracted, and C. trachomatis, N. gonorrhoeae, and HPV infections were detected using established PCR primers and protocols. PCR controls included no confirmatory template controls or human β-globin. Patients infected with C. trachomatis were treated with doxycycline and re-examined after treatment. C. trachomatis major outer membrane (ompA) and tryptophan synthesis A (trpA) genes were sequenced to identify possible genetic mutations associated with persistence and/or drug resistance.
Results
C. trachomatis, N. gonorrhoeae, and HPV were detected in 22%, 6%, and 48% of symptomatic, and in 3%, 16%, and 10% of asymptomatic women and girls, respectively. Coinfection with C. trachomatis and HPV were frequent in the 15-34 year age group, and associated with upper urogenital tract symptoms. Doxycycline was not considered effective for C. trachomatis infection. Several nonconserved amino acid changes were detected in C. trachomatis ompA and trpA.
Conclusion
We found different distributions of these pathogens among symptomatic and asymptomatic patients. We also found doxycycline treatment failures, and mutated trpA supported persistent C. trachomatis infections.